Now opioids across the lifespan are particularly problematic.
Elderly and infants are very sensitive to opioids so you want to use extra caution
with these special populations.
Now we took a second slide to make this point cuz remember neonates
and infants have immature blood brain barriers so you have to use extreme caution
when you’re considering the use of opioid in this particularly vulnerable and tiny population.
Now here’s another grouping of who you want to avoid opioid use with.
First of all, pregnancy or labor and delivery - wow, you're thinking like, man,
that’s pretty painful, why wouldn’t we use opioids?
Well, in labor and delivery opioids can suppress uterine contractions - that’s not a good idea, right?
And it can also cause respiratory depression in the neonate,
so that’s why we avoid opioids; we use other medications in labor and delivery.
Head injuries, we just walk through that so see what you can pause and recall about head injuries.
What are two reasons we would try to avoid opioid use in patients who suffered a head injury?
Welcome back, let’s look at the third person.
People who are respiratory compromised - they’re not on the ventilator, that mean supported;
they’re not on the ventilator and their compromised respiratory-wise.
They might have really bad lungs or severe COPD or asthma - you wanna be very careful with that
because we know that opioids can cause respiratory depression.
If they are already struggling in their respiratory status because of a disease process or an injury
and we don’t have them on a ventilator, then we wanna be very careful with opioid use.
Now of course opioids and alcohol or any other CNS suppressant is a bad idea - cannot stress that enough.
Opioids and alcohol is a real risk for overdose and risking the patient’s death.
Now there’s long term issues that are included with opioids, there's tolerance.
Now they develop a tolerance to analgesia, euphoria, sedation
and thankfully to respiratory depression, that’s one bit of a positive.
You see the problem with taking opioids long term is that you need more and more and more
to get pain relief that you need.
Now even in an appropriate clinical setting I’m gonna look at the administration of an opioid to one patient
who’s never had them, we call them naïve versus a patient who’s had multiple doses of opioids.
The person who’s never had opioids before is gonna take a much smaller dose
because they haven’t developed tolerance.
The person who’s taken lots of opioid for appropriate reason is gonna have a tolerance to pain relief
so they're gonna take much bigger doses in order to get that pain relief.
Now, sadly, opioid tolerance never develops to constipation, that would be fantastic if it did.
It also doesn’t to miosis but constipation is a really problem.
So on special note, if I have a tolerance to one opioid agonist,
I’ll have a cross-tolerance to another opioid agonist
so if I've been on one opioid agonist, anyone of the examples that we’ve talked about
and I’ve built up a tolerance to it, it doesn’t matter what opioid agonist you give me,
I’ll still have a tolerance build up to that one, we call it a cross tolerance.
Now physical dependence is the need for opioids in order to avoid the withdrawal symptoms,
so my body is so used to getting these opioids it’s physically dependent on them.
If I don’t have them I’m gonna go through these miserable withdrawal symptoms,
so even if I've been on an appropriate prescription for as little as 20 days
but it’s a pretty high dose, my body will develop physical dependence.
That’s why it’s very important with opioids and all CNS medications not to just stop them abruptly.
You wanna wean those opioids over a period of time, that means you'll gradually decrease the dosage
and increase the length of time in-between doses so that you can avoid the withdrawal symptoms.